Surgical treatment of vertebral artery-posterior inferior cerebellar artery dissecting aneurysms

Abstract

To study an effective method for vertebral artery-posterior inferior cerebellar artery (VA-PICA) dissecting aneurysms. Five patients with VA-PICA dissecting aneurysms were treated surgically between December 2007 and February 2010, who were all males, aged from 40 to 55 years. Four of them presented with subarachnoid hemorrhage (SAH), 1 of them suffered from an intermittent headache on occipital area about 4 months. All the aneurysms were trapped via a far-lateral approach after revascularization of the PICAs by occipital artery-posterior inferior cerebellar artery (OA-PICA) bypass. Among the 5 patients, 1 of them got a good outcome without any neurological deficit after surgery, 3 of them had postoperative lower cranial nerve palsy, 1 of them complicated with bleeding in the operative field after postoperative antithrombotic treatment, and suffered from contralateral hemiplegia after second surgery of removing hematoma. Postoperative cerebral angiographies (received by 2 patients) and CT angiographies (received by 3 patients) all showed patent bypasses and no filling of the aneurysms. During the follow-up from 2 to 29 months, 4 patients got good outcomes, 1 patient still suffered from moderate hemiplegia. Trapping the aneurysms after revascularization of PICA by OA-PICA bypass should be an effective method to treat the VA-PICA dissecting aneurysms, but individualized strategies also need to be considered based on different cases.